Monitoring oral anticoagulant treatment with the TAS near-patient test system: comparison with conventional thromboplastins.
BACKGROUND
A number of instruments have been developed for determination of prothrombin time (PT) and International Normalised Ratio (INR) at locations not limited to central laboratories.


OBJECTIVE
To evaluate one such portable instrument, the Thrombolytic Assessment System (TAS), which can be used in a near-patient setting.


METHODS
Samples from 20 normal subjects and 48 patients treated with warfarin for venous thromboembolic disease were studied. The warfarin group was divided into: initiation phase (n = 10), combined warfarin and heparin (n = 10), stabilised therapy (n = 20), and over anticoagulated patients (n = 8). PTs and INRs were determined in each group using three conventional thromboplastins (Diagen Activated, Manchester Reagent, and Instrumentation Laboratory) and two TAS techniques (whole blood or plasma). An independent International Sensitivity Index (ISI) calibration of the TAS system was performed.


RESULTS
Calculated ISIs for the TAS were 1.028 and 0.984 for plasma and whole blood analysis, respectively, compared with manufacturer's values of 0.98 and 0.97. INR results with TAS (whole blood) were 11% less than those obtained with Diagen Activated (p < 0.01) and 16% less than those obtained with Instrumentation Laboratory (p < 0.001) when manufacturers' mean normal PT and ISI were used for TAS INRs. TAS (whole blood) results were similar to TAS plasma or Manchester Reagent results. The use of a locally determined mean normal prothrombin time (MNPT) improved agreement between TAS and the other reagents, abolishing the significant difference between INRs determined with TAS (whole blood) and Diagen Activated techniques.


CONCLUSIONS
The TAS system can be used with whole blood or plasma and produces similar INRs to those obtained with Diagen Activated or Manchester Reagent using manufacturer's ISI and a locally determined MNPT. Results were lower with TAS or Manchester Reagent compared with those obtained with Instrumentation Laboratory thromboplastin.
Kitchen
S
S
Department of Coagulation, Royal Hallamshire Hospital, Sheffield, UK.
Preston
F E
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D000925:Anticoagulants / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000295:instrumentation*; D004359:Drug Therapy, Combination; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D019095:Point-of-Care Systems; D011517:Prothrombin Time; D015203:Reproducibility of Results; D013923:Thromboembolism / Q000097:blood / Q000188:drug therapy*; D013925:Thromboplastin; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D013925:Thromboplastin